Mental illness in a broad sense is a more abstract genre of illnesses in many cases, specifically with Bipolar Disorder, which makes it important to listen to individuals expressing themselves rather than relying on observation. Expressing one’s self may be challenging for the average adult, imagine how difficult it can be for children and teenagers. For this reason and many others, “the diagnosis of bipolar disorder (BD) in youth is confusing and controversial.” Some people might note that children go through mood swings all the time, however, “bipolar symptoms are more powerful than” the normal ups and downs children may go through because “the mood swings are more extreme and are accompanied by changes in sleep, energy level, and the ability to think clearly.” With the fine line still blurred, Youngstrom, Birmaher & Findling reveal some evidence as well as critiques regarding the phenomenology, the science behind the phenomena, and validity of pediatric bipolar disorder.
Youngstrom et al. finds it difficult to make concrete conclusions from various symptoms said to be associated with pediatric bipolar disorder. With analysis, they saw that “many of these [symptoms] are behaviors that, although strongly associated with pediatric BD, are not specific to the disorder, and thus often occur in the context of other conditions” (Youngstrom, Birmaher & Findling, 2008). Due to this observation, physicians are recommended to question whether symptoms are confirming the diagnosis of pediatric bipolar disorder or suggesting other disorders.
In the recent decades, advances have been made to validate the diagnosis of bipolar disorder in children and adolescents. Youths who are diagnosed usually “show considerable impairment, a strong familial association with mood disorder (and BD in particular), and morphological features and neuroaffective functioning that are consistent with findings in adults with BD, all of which are suggestive of continuity between the pediatric and adult diagnoses” (Youngstrom, Birmaher & Findling, 2008). However, notable areas of disagreement within the phenomenology of pediatric bipolar disorder are the concrete definition of elated mood in contrasts with irritable mood as well as if one of the major sources of consult, the Diagnostic and Statistical Manual (DSM-V), that identifies the most relevant and accurate categories for bipolar disorder. Nevertheless, future research perspectives including twin and adoptive studies should shed more light on pediatric bipolar disorder.
The child psychiatrist perspective also reveals more about the illness, starting with the idea that pediatric bipolar disorder might be an epidemic in the United States because the diagnosis has increased 40-fold in the past decade. In 1996, bipolar disorder was the least frequent diagnosis for children, and we saw that in 2004, it was the most frequent diagnosis for children admitted to psychiatric inpatient centers (Stebbins & Corcoran, 2016). After collecting data from four inpatient and outpatient clinics, both public and private, Stebbins and Corcoran saw several themes when the data was analyzed. The first was that pediatric bipolar disorder is overdiagnosed. The second step, as you may guess, is to ask ourselves why is this so? The data supports that “there is a lack of clarity in the diagnosis” (Stebbins & Corcoran, 2016) and that “medical professionals not trained in psychiatry were assessing and diagnosing children” (Stebbins & Corcoran, 2016). Another theme supported by the data is that the environment in which the child lives has a greater impact than biological risk factors. Children under chronic stress, trauma and or abuse were greatly influenced by their environment.
Although Stebbins and Corcoran’s study is preliminary and additional investigations are needed for many pediatric mood disorders, we were able to understand the downfalls of the diagnosis of pediatric bipolar disorder as well as the merit through Younstrom et al. What we should keep in mind is the effects, a diagnosis of bipolar disorder in adolescents is in terms of the medication prescribed and quality of life. Therefore, directions for future perspectives include solidifying the diagnostic criteria, increasing psychiatric training, and placing more significance on environmental influences and how it can be mediated for the benefit of the child.
References:
Lee, T. (2016). Pediatric bipolar disorder. Pediatric Annals, 45(10), e362-e366. doi:10.3928/19382359-20160920-01
NIH. (2015). Bipolar Disorder in Children and Teens. Retrieved January 23, 2017, from https://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens/index.shtml
Stebbins, M. B., & Corcoran, J. (2016). Pediatric bipolar disorder: The child psychiatrist perspective. Child & Adolescent Social Work Journal, 33(2), 115-122.
Youngstrom, E. A., Birmaher, B., & Findling, R. L. (2008). Pediatric bipolar disorder: Validity, phenomenology, and recommendations for diagnosis. Bipolar Disorders, 10(1 PART 2), 194-214.
Informative